ABA RESOURCES: INTRODUCTION

What is ABA?

Behavior Analysis is the scientific study of behavior. Applied Behavior Analysis (ABA) is the application of the principles of learning and motivation from Behavior Analysis, and the procedures and technology derived from those principles, to the solution of problems of social significance. Many decades of research have validated treatments based on ABA.

The Report of the MADSEC Autism Task Force (2000) provides a succinct description, put together by an independent body of experts:

Over the past 40 years, several thousand published research studies have documented the effectiveness of ABA across a wide range of:

Applied behavior analysis is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior (Baer, Wolf & Risley, 1968; Sulzer-Azaroff & Mayer, 1991).

DISCRETE TRIAL TRAINING

Discrete trial training (DTT) is a particular ABA teaching strategy which enables the learner to acquire complex skills and behaviors by first mastering the subcomponents of the targeted skill. For example, if one wishes to teach a child to request a a desired interaction, as in "I want to play," one might first teach subcomponents of this skill, such as the individual sounds comprising each word of the request, or labeling enjoyable leisure activities as "play." By utilizing teaching techniques based on the principles of behavior analysis, the learner is gradually able to complete all subcomponent skills independently. Once the individual components are acquired, they are linked together to enable mastery of the targeted complex and functional skill. This methodology is highly effective in teaching basic communication, play, motor, and daily living skills.

Initially, ABA programs for children with Autism utilized only (DTT), and the curriculum focused on teaching basic skills as noted above. However, ABA programs, such as the program implemented at CARD, continue to evolve, placing greater emphasis on the generalization and spontaneity of skills learned. As patients progress and develop more complex social skills, the strict DTT approach gives way to treatments including other components.

Specifically, there are a number of weaknesses with DTT including the fact the DTT is primarily teacher initiated, that typically the reinforcers used to increase appropriate behavior are unrelated to the target response, and that rote responding can often occur. Moreover, deficits in areas such "emotional understanding," "perspective taking" and other Executive Functions such as problem solving skills must also be addressed and the DTT approach is not the most efficient means to do so.

Although the DTT methodology is an integral part of ABA-based programs, other teaching strategies based on the principles of behavior analysis such as Natural Environment Training (NET) may be used to address these more complex skills. NET specifically addresses the above mentioned weaknesses of DTT in that all skills are taught in a more natural environment in a more "playful manner." Moreover, the reinforcers used to increase appropriate responding are always directly related to the task (e.g., a child is taught to say the word for a preferred item such as a "car" and as a reinforcer is given access to the car contingent on making the correct response). NET is just one example of the different teaching strategies used in a comprehensive ABA-based program. Other approaches that are not typically included in strict DTT include errorless teaching procedures and Fluency-Based Instruction.

At CARD all appropriate teaching approaches based on the well grounded principles of applied behavior analysis are utilized.

RELIABLE MEASUREMENT

Reliable measurement requires that behaviors are defined objectively. Vague terms such as anger, depression, aggression or tantrums are redefined in observable and quantifiable terms, so their frequency, duration or other measurable properties can be directly recorded (Sulzer-Azaroff & Mayer, 1991). For example, a goal to reduce a child's aggressive behavior might define "aggression" as: "attempts, episodes or occurrences (each separated by 10 seconds) of biting, scratching, pinching or pulling hair." "Initiating social interaction with peers" might be defined as: "looking at classmate and verbalizing an appropriate greeting."

ABA interventions require a demonstration of the events that are responsible for the occurrence, or non-occurrence, of behavior. ABA uses methods of analysis that yield convincing, reproducible, and conceptually sensible demonstrations of how to accomplish specific behavior changes (Baer & Risley, 1987). Moreover, these behaviors are evaluated within relevant settings such as schools, homes and the community. The use of single case experimental design to evaluate the effectiveness of individualized interventions is an essential component of programs based upon ABA methodologies.

This process includes the following components:

selection of interfering behavior or behavioral skill deficit

identification of goals and objectives

establishment of a method of measuring target behaviors

evaluation of the current levels of performance (baseline)

design and implementation of the interventions that teach new skills and/or reduce interfering behaviors

continuous measurement of target behaviors to determine the effectiveness of the intervention, and

ongoing evaluation of the effectiveness of the intervention, with modifications made as necessary to maintain and/or increase both the effectiveness and the efficiency of the intervention. (MADSEC, 2000, p. 21-23)

As the MADSEC Report describes above, treatment approaches grounded in ABA are now considered to be at the forefront of therapeutic and educational interventions for children with autism. The large amount of scientific evidence supporting ABA treatments for children with autism have led a number of other independent bodies to endorse the effectiveness of ABA, including the U.S. Surgeon General, the New York State Department of Health, the National Academy of Sciences, and the American Academy of Pediatrics (see reference list below for sources).

SOCIALLY SIGNIFICANT BEHAVIORS

"Socially significant behaviors" include reading, academics, social skills, communication, and adaptive living skills. Adaptive living skills include gross and fine motor skills, eating and food preparation, toileting, dressing, personal self-care, domestic skills, time and punctuality, money and value, home and community orientation, and work skills.

ABA methods are used to support persons with autism in at least six ways:

THERAPY/SUPERVISION

Lesson Areas and Sample Targeted Skills
Following the principles of Applied Behavior Analysis, we developed a treatment approach for children with autism, up to age eight, that focuses on minimizing challenging behaviors and maximizing skill acquisition. Once new behaviors are mastered, we focus on generalization with the goal of transitioning each child into the mainstream educational system. If necessary, we also provide school shadowing services so children have the support they need in the classroom.

Challenging Goals; Trackable Progress
We teach self-help and safety skills, build language and communication, as well as an array of advanced skills such as theory of mind, social skills, and executive functioning. With the input of parents and the child’s caregivers, we set challenging goals for our team and the child and track progress on each skill domain carefully.

The program is developed and managed by a highly trained CARD supervisor who tailors the program to each child’s needs. A team of therapists implements the plan and participates in training and team meetings to ensure consistency. The entire treatment team, including all caregivers (mom, dad, grandparents, and siblings) is invited to participate in regular “clinic meetings” designed to review the child’s progress, train on new techniques and add lessons to the program.

The CARD Goal
While each student will come to us with unique needs, we have developed a set of long-term goals that are important for all students to work toward achieving. The CARD goal is to teach independence skills, appropriate social activities and relationship building, as well as many other skills.

For more information about the CARD program for your child, please call us at 1-855-345-2273.

ASSESSMENT: OVERVIEW

Our team of licensed psychologists and highly trained doctoral level assessors design testing batteries based on the individual needs of each referred client to best inform treatment programming and improve daily functioning in home, academic, social, and professional environments.

Infant, child, adolescent, and adult clients referred internally through CARD and from the outside community are provided diagnostic and annual assessments focused in the areas of cognitive, language, adaptive, academic, social, emotional, behavioral, and executive functioning.

Evaluations can be designed to assess:

Cognitive Functioning

Attention & Mental Control

Processing Speed

Executive Functioning

Language Abilities

Adaptive Functioning

Verbal Learning & Memory

Nonverbal Learning & Memory

Visual Perception

Behavioral & Emotional Functioning

Social Skills & Social Cognition

Academic Achievement

Neurodevelopmental Disorders can be diagnosed or ruled-out, including:

ASSESSMENT: WHAT TO EXPECT

The assessment process begins with a Referral to the Assessment Center. Internal clients are referred by their ABA supervisor or contacted by the Assessment Center if the client is due for his or her annual evaluation. External clients and those new to CARD can contact the Assessment Center directly to request a comprehensive evaluation.

Evaluations for infant, child, adolescent, and adult individuals new to CARD and from the outside community are available. Interested individuals and families are encouraged to contact the Assessment Center by phone or email to inquire about receiving a comprehensive evaluation. An initial Phone Intake will be provided to best assess the individual’s needs and payment options will be discussed.

The Evaluation will consist of one or more scheduled sessions consisting of a pre-determined battery of testing materials to evaluate the client in one or more of the following areas: Cognitive Functioning, Attention & Mental Control, Processing Speed, Executive Functioning, Language Abilities, Adaptive Functioning, Verbal Learning & Memory, Nonverbal Learning & Memory, Visual Perception, Behavioral & Emotional Functioning, Social Skills & Social Cognition, and Academic Achievement.

A Feedback Session with you and your CARD supervisor will be arranged in order to explain test findings, discuss implications to programming, and review recommendations to support the client in his or her home, academic, social, and community environments.

CENTER-BASED SERVICES: Overview

Center-Based Services are one-to-one applied behavior analysis (ABA) sessions for children and adults that take place at a CARD center rather than in the home environment. Clients are able to access the cutting edge CARD curriculum while receiving excellent care from top ABA therapists and Board Certified Behavior Analyst (BCBA) supervisors.

There are many benefits to Center-Based Services:

Clients can be matched by age and level of functioning for socialization opportunities and peer play dates

A perfect setting for generalization, allowing clients to use acquired skills in a new way, at a new place

Immediate access to supervisors

Engagement with new toys and materials

Free time for parents to work, attend meetings, or run errands–all while your child is learning at the center

Variation in your weekly schedule (you can do some sessions at the center, some at home)

Your CARD center provides a fun and welcoming atmosphere, where your child can interact with a number of staff members and other clients, all while learning the same lessons, behaviors and skills they would at a home session.

SOS: SPECIALIZED OUTPATIENT SERVICES

ELIMINATE YOUR CHILD'S CHALLENGING BEHAVIOR - FAST.

CARD SOS provides services to individuals with and without developmental disabilities.

What is S.O.S.?

CARD's Specialized Outpatient Services (S.O.S.) is a unique service that targets a child's more extreme behavior which can make daily life difficult for a family. These services are a short-term intervention meant to fill any potential gaps not covered by other therapies. Our goal is to make the home lives of our clients as enjoyable and productive as possible.

The behaviors addressed by CARD S.O.S. tend to be more severe in nature. Often other providers have attempted unsuccessfully to address these behaviors. Utilizing the principles of Applied Behavior Analysis, the CARD S.O.S. team provides consultation and direct one-to-one intervention to reduce inappropriate behaviors and increase socially appropriate behaviors.

Duration of Services and Fees

CARD S.O.S. works with each family to determine particular needs. Our goal is to provide services in an effective and efficient manner. The duration and intensity of services are individualized. All assessment, treatment, and report-writing services are provided on a flat hourly rate. Please contact CARD S.O.S. to receive more information.

How to Get Started

CARD S.O.S. services families and individuals all over the world. However, because of staffing and logistical limitations, some services are only available in certain locations. For more information or to start the intake process, contact CARD S.O.S at 855-345-2273.Typically, after a brief phone consultation, we will schedule an initial evaluation and provide recommendations. Once accepted, services can begin.

THERAPY PROGRAMS: CARD CLASSES

The Center for Autism and Related Disorders, LLC. (CARD) offers a variety of customized, hands-on classes and seminars that provide ongoing development for families, caregivers, professional educators, clinicians, and students with the opportunity to benefit from over 150 years of combined experience in Applied Behavior Analysis (ABA).

CARD Classes are held at a variety of CARD office locations, as well as community centers around the country. Please click on the links below to learn more about each opportunity and register today! If you have any questions, please contact: (855) 345-2273

UPCOMING CLASSES

Social Skills Groups for Kids (Ages 6-12)

Ongoing classes
Fresno, California

Social Skills Groups for Teens (13-19)

SOS: CHALLENGING BEHAVIOR CLINIC

Autism presents families with numerous hurdles to overcome on a daily basis. Behavior problems are often one of the most cited concerns by parents. These issues not only inhibit the development of the child, but can curtail the activities of the family as a whole.

Common behavior problems seen within the autism spectrum that can cause significant harm to the child and others can include:

Self-injury (self-biting, scratching, pinching, hitting, etc.)

Aggression toward others

Property destruction

Pica (eating inedible objects)

Non-compliance

Although perhaps not as serious, there are other sets of challenging behaviors that our clients display that make the home environment more challenging. These include:

Sleep dysregulation

Inappropriate toileting

Inappropriate sexual behavior

Behavioral Intervention

Behavioral interventions have been utilized to address challenging behavior for decades. Between the years of 1960-1995, over 550 peer-reviewed studies were published documenting the effectiveness of Applied Behavior Analysis techniques in teaching skills to children with autism (Matson, et al, 1996). Currently, ABA-based interventions are considered to be the gold standard in intervention The CARD Challenging Behavior Clinic provides services for individuals with and without developmental disabilities, who display problem behavior in the home, school, and/or community setting. Utilizing the principles of Applied Behavior Analysis, the CARD S.O.S. team provides consultation and direct one-to-one intervention to reduce inappropriate behaviors and increase socially appropriate behaviors. Using state-of-the-art functional assessment procedures, presenting symptoms are identified and assessed. A function-based intervention is then developed to replace the challenging behaviors with newly-acquired, appropriate skills. Skills that are targeted for acquisition range from basic language and play skills to more complex social skills. Once new behaviors are mastered, CARD focuses on generalization of the newly-acquired skills to the home, school and community settings. Significant time and effort are invested in caregiver training to ensure that the child uses the new, appropriate behaviors with individuals besides the therapists.

SOS: FEEDING CLINIC

For many children and adults, great joy can be found in the act of eating. However, for some children, this seemingly simple act can cause great strain on the individual and the family.

Pediatric feeding disorders occur when a child does not consume enough food or liquid to gain weight and grow as expected. On a whole, feeding issues are relatively common in children and even more common in children with developmental disabilities. However, the severity of feeding issues can differ greatly from child to child.

CARD SOS CASE STUDY:

At the beginning of his services with the CARD’s SOS Feeding Clinic, Mitchell was small for his age, being within the 10th and 25th percentiles for height and weight for his age. Upon discharge, Mitchell is 37.5 lbs (on the 50th percentile) and 38 inches tall (between the 25th and 50th percentiles).

MITCHELL

BEFORE

AFTER

Age

3 y 5m

3y 10m

Weight

30 lb

37.5 lb

Height

36"

39"

Texture of Food

Mushy (i.e. porridge, mashed potato)

Regular texture, bite size

Seating

High chair, bath, tub

In age appropriate booster seat

Feeding Style

Mom fed him

Self-feeder

Amount of Time Per Day Feeding Him

5 meals, each at least 1 hour

4 meals, each averaging 30 minutes

Variety

Less than 10 foods eaten consistently, only water

Anything we put in front of him. At least 40 different foods

Inappropriate Mealtime Behaviors

Gagging, crying, throwing up, cough, giving back food

Almost non-existent

Chewing

Swallowed food whole

Self-regulates chewing

A child with a feeding disorder may only eat a few foods, completely avoiding entire food groups, textures, or liquids necessary for proper development. As a result, children diagnosed with feeding disorders are at greater risk for compromised physical and cognitive development. Children with feeding disorders may also develop slower, experience behavioral problems, and even fail to thrive. Severe feeding disorders can cause children to feel socially isolated and often put financial strains on families.

There are many different types of feeding disorders, and they can take on one or more of the following forms:

Difficulty accepting and swallowing different food textures

Throwing tantrums at mealtimes

Refusing to eat certain food groups

Refusing to eat any solids or liquids

Choking, gagging, or vomiting when eating

Oral motor and sensory problems

Dependence upon high-calorie substances

Gastrostomy (g-tube) or naso-gastric (ng-tube) dependence

In most cases, no single factor accounts for a child’s feeding problem. Rather, several factors can interact to produce them. Feeding disorders typically develop for several reasons, including medical conditions (food allergies), anatomical or structural abnormalities (e.g., cleft palate), and reinforcement of inappropriate behavior. Unfortunately, at this time, the concise etiology of pediatric feeding disorders is still unknown.

While a wide variety of factors can contribute to feeding disorders, certain medical and psychological conditions may accompany feeding disorders more often, such as:

Awareness of risk factors and clinical presentations of feeding disorders, combined with appropriate referrals at an early age, will produce the best outcomes for children and their families.

Feeding Disorders Within the Autism Spectrum

Although it has long been reported by parents, recent research has shown that there are significant differences in the eating patterns of children with autism and those who are neuro-typical. Children with autism are shown to be more selective in the types of food eaten, textures of food, and variety. Additionally, these children tend to need more specific environments and utensils (Shreck 2006). Nutritional intake is also seen to be lower for children on the autism spectrum (Bandini, 2010; Cermak, 2009).

Behavioral Intervention for Feeding Disorders

Behavior disorders (including feeding disorders) often involve an interaction of operant and biological variables. Behavioral psychology allows for systematic analysis of environmental variables. This allows the underlying function of the target behavior to be covered. Treatment intervention can then be developed fully when the function is known (Piazza 2003a).

Behavioral interventions have been shown to be useful in reducing and even eliminating not only tantrums and non-compliance during meals but, also, even the use of tube feedings (Piazza 2003b; Matson, 2005; Linschield, 2006). Interventions of these types have been published in peer-reviewed literature dating back to the mid-1970s.

The CARD Feeding Clinic provides services for individuals (a) with and without developmental disabilities, (b) who display difficulties in self-feeding or have problems such as partial or total food refusal or food selectivity by type or texture, and (c) who do not have a feeding disorder of a biological basis (as determined by a pre-screened medical examination).

Trained clinicians design interventions based on the results of a systematic assessment of an individual’s feeding problem. Intervention cane be provided either in the clinic or home setting.

As individuals show consistent improvement in feeding skills, caregivers are trained to implement interventions with clinician support. Treatment goals have been met once individuals demonstrate generalization to novel foods, and are eating well with caregivers in the home setting, and caregivers feel confident implementing procedures independently.

SOS: MEDICAL FACILITATION CLINIC

There are many ways to compromise medical interventions. One oft-cited reason is simply failure to comply with recommendations. This includes non-compliance with medication as well as regular testing, follow-up visits, and examinations. For children on the autism spectrum, this failure to comply can be taken to an even greater level involving tears and tantrums due to possible difficulties with sudden changes in environments and routines.

The Medical Facilitation Clinic provides behavioral services to individuals to assist in assuring the individual’s adherence to medical procedures. Medical procedures include, but are not limited to, the administration of oral medication (capsules and tablets), capsule endoscopy, physical examinations, dental visits, obtaining vital signs, and IV procedures. Families are required to show documentation of a thorough physical examination by a licensed physician prior to intervention.

After a review of the client’s medical history, our staff is able to design a personalized behavioral intervention to teach the client necessary new skills and to desensitize him/her to medical procedures. Once the individual has shown mastery of the specific procedure, all caregivers are trained to implement the successful intervention.

CASE STUDY

9-year old Eli was required to take 9 pills each day to adhere to his medical regimen. At the beginning of treatment, Eli willingly put the pill in his mouth, but was not able to swallow it. Using size fading, Eli began his intervention using very small placebo pills (tapioca). Once he was successful in swallowing that size, the size was increased systematically. When he was able to swallow the biggest pill size (capsule size 0), his mother began to run the sessions with great success.

SCHOOL CONSULTATIONS

The staff at CARD S.O.S. is thrilled to provide our services and experience to school districts.

The Individuals with Disabilities Education Act (IDEA) requires that IEP teams address behavior problems that interfere with a child's ongoing learning. This includes conducting a functional behavior assessment to determine the underlying reasons that the problem behavior occurs. Once the function of the behavior is known, an intervention based upon that function can be constructed. Function-based interventions are shown to be more effective and long lasting in addressing problem behavior

Staff members are able to meet with school personnel, families, and the children in order to conduct a thorough functional assessment. This can include:

Indirect functional assessment

Direct functional assessment

Experimental functional analysis

All assessments are tailored to the individual child. Behavioral recommendations can be provided upon request to guide the formation of a child's Behavior Intervention Plan (BIP).

REMOTE CLINICAL SERVICESNot near a CARD office? We can still help!

If there is no CARD office near you, our supervisors can travel to your family and provide the training your child needs. Remote clinical trainings include:

Understanding autism

ABA basics

Skills® assessments

Skill acquisition and maintenance

Behavior management

Demonstration/modeling/role-play

Practical training with child

Ongoing observation and specialized support for child and family

CARD is committed to providing top-quality therapy and supervision around the globe to families affected by autism spectrum disorder (ASD). With Remote Clinical Services, your family is individually matched with a CARD supervisor who travels to your home to meet with parents and caregivers. The supervisor initiates an in-depth and ongoing assessment to identify treatment goals and develop an individualized treatment plan for your child that fits your family’s needs. During the first visit, the supervisor puts behavior and skill acquisition plans in place specifically tailored to your child. Throughout the therapy process, your supervisor provides ongoing support to ensure the effectiveness and integrity of the treatment plan. Your CARD supervisor can also assist in school planning, report writing, and training additional staff. If requested, CARD can even hire and train therapists in your area to provide therapy in the home or out in the community.

CARD’s online assessment tools and training programs allow us to offer quality and consistency all over the world.

Assessment, curriculum, and behavior plans can be updated instantly with SKILLS®, the CARD online assessment tool based on 30 years of clinical research. For more information, visit www.skillsforautism.com.

CARD’s highly regarded training programing is also available online to train individuals in your community to become therapists. CARD’s eLearning™ program provides in-depth training on the principles and procedures of applied behavior analysis, an evidence-based approach to treating the challenges and delays associated with autism spectrum disorder. For more information, visit www.ibehavioraltraining.com.

The CARD Model is available to all autism treatment professionals through the CARD Affiliate Program, helping agencies worldwide address the needs of their local autism population. This unique partnership between CARD and other treatment providers produces exceptional clinical outcomes while building sustainable local businesses. Initially, clients, families, and affiliate staff receive direct supervision from CARD. As the program develops and the affiliate staff gain experience and training, clinical services may be provided independently. Affiliates work directly with a team of CARD clinicians who have extensive training and years of experience. Our CARD team designs the client treatment and supervision plans and teaches affiliate staff to develop and implement these plans themselves.

At CARD Remote Clinical Services, we work diligently to provide global access to top-quality, evidence-based treatment and to help small business owners build sustainable companies. For more information, contact us at (855) 345-2273 or email us.

CARD - An Ever Growing Family

As a core value of the CA mission, CARD is always looking to grow our family. If you are interested in CARD acquiring, developing and/or partnering with your agency, simply send an e-mail to mergers@centerforautism.com